Given how common sprained ankles are, it is surprising how few people clearly understand what effective treatment and rehabilitation looks like. We often work with accomplished athletes who aren’t clear what sprained ankle treatment involves, or how to ensure the sprained ankle doesn’t re-occur. Here is a basic overview of effective sprained ankle treatment and rehabilitation.
Phase 1 – Acute Sprained Ankle Treatment
Reduce swelling – Prevent Further Damage
This phase of sprained ankle treatment is the one that most people have a fairly good grasp of. The RICE principle makes it nice and easy to remember Rest, Ice, Compression, Elevation.
Get the swelling down using gravity and ice plus don’t do any further damage!
This is a fairly intuitive and common sense phase of sprained ankle treatment. Most athletes and active people are aware of these principles and most do a pretty good job of treating sprained ankles in this early phase. But a reduction in swelling and pain does not necessarily indicate a full healing or successful treatment of a sprained ankle.
This second phase of sprained ankle treatment is often completely overlooked. The hallmark of this phase is having someone (usually a professional) get stuck into some hands on treatment. In our clinic Phase 2 sprained ankle treatments include acupuncture, manual mobilisation, deep tissue release, hot & cold, vibration massage, guasha ( scraping scar tissue ) & joint manipulation.
For reasons as yet not known to science the sub acute phase of sprained ankle treatment often requires a great deal of work. Work is also required in maintaining the body in good general health so perhaps it’s not so surprising that healing sprained ankles is not entirely spontaneous. Effective exercise is a ‘variety or novelty based form of physical agitation’ that maintains the body in good health. In other words we challenge the body when we exercise. Phase 2 sprained ankle treatment is also a ‘variety or novelty based form of physical agitation’ that stimulates deeper resolution of injury in damaged soft tissues. By gently agitating the tissue through this phase we can encourage the body to continue the healing process.
Phase 3 – Rehabilitation of Sprained Ankle – Beyond Treatment
Restore Full Joint Movement – Strengthen Muscle – Re-Establish Proprioception
This phase of healing and treatment for sprained ankles is commonly understood but seldom followed through on particularly well. Even when Phase 1 & 2 of appropriate sprained ankle treatment have been observed, almost all patients will end up with a trio of joint stiffness, loss of muscle strength & poor proprioception (think balance) following a decent sprained ankle event.
As a clinic team we have learned that many patients have already developed weaknesses gradually before the sprained ankle incident … a kind of chicken / egg scenario. This fact reaffirms the importance of considering a slightly longer term Phase 3 than is traditional.
Without going into the specifics (which are for another post on another day) Phase 3 should involve AT LEAST 3-6 MONTHS of daily proprioceptive and ankle mobility work for the ankle to be safe. This is in actuality fairly straight forward and just involves 10 mins a day on a wobble board plus a couple of mobility exercises. Really bad sprains actually warrant a couple of years of steady attention in this way and should be tested regularly for proprioceptive gains!
This all may seem like a lot of work. It is worth bearing in mind, the incidence of re-injury and the need for further treatment even years later with sprained ankles, is astronomically high.
Severity, treatment and rehabilitation are probably the most influential factors in determining sprained ankle recovery time. As we have seen here, early interventions are seriously effective in reducing recovery time in the early phases of healing but many sprained ankles have needs that go way beyond ice and rest.
Our ankles and feet in many ways connect us to our quality of life. Most of the things we like to do involve movement and some of them involve a lot of movement. Diligent sprained ankle treatment actioned in a timely fashion is something that has the ability to affect the quality of life and physical freedom of those who need it most… and it’s EASY with the right mindset and the right tools.
An anecdote that might be motivating relates to a patient who we assisted a number of years ago. The lady in question had the worst case of ankle pain and the worst history of ankle sprains we have ever encountered.
She had suffered a very bad sprain in her early 20’s playing netball. In the following 20 or so years she had a significant number of additional sprained ankles each requiring treatment. In the end she had constant daily stabbing pains with movement in her ankle, year in and year out. She eventually managed to reduce her activity levels to where she no longer sprained her ankles but she still suffered with persistent ankle pain. The situation was grave as it also meant she struggled with weight gain because she couldn’t exercise normally.
By the time she reached her mid 50’s she had had enough and agreed to let a surgeon fuse her ankle joint. The surgery was as successful as one could hope for as it left her with 80% less pain while walking but it changed her gait permanently and left her with a limp.
There were 2 very noticeable things about this ladies history of sprained ankles and treatment. The first notable thing was how horrendously bad her case was, few people with ankle problems have it as bad as she did. The second most notable thing was how she managed her initial sprain which had been a bad one. She chose to hobble around for nearly a year with her badly sprained ankle without seeking any treatment. She never had any treatment, never did any exercises and never tended to the injury. Where most people with a sprain as bad as hers would have sought sprained ankle treatment from a doctor, physiotherapist or sports chiropractor she has soldiered on thinking it would eventually come right.
It seems highly likely that by just keeping on using her ankle and by not seeking treatment for her sprained ankle or doing any rehabilitation she had opened the door to years of pain, suffering and ultimately degeneration. The legacy of scar tissue and muscle wasting that develop around unattended and unloved injuries can be quite shocking when you see how much it can effect the health and happiness of people who otherwise have everything going for them.